Purpose

To describe the reimbursement databases available in France for pharmacoepidemiological research and their use.



Methods

France has a publicly funded health system that systematically covers the population. Within this system, three main insurance schemes provide health services to citizens in France and each have their own reimbursement database. Together these three databases cover almost 97% of the French population (respectively for 54.5, 3.6, and 3.3 million individuals, and a total of 61.4 million individuals). Data in these concern patients, prescribers, all the medical acts reimbursed, prescription and undertaking of laboratory tests (but without results), private hospital data, partial public hospital data and vital status. Their use is regulated but access is free and the data are anonymous. PubMed and Scopus were searched for relevant studies published from January 1988 to June 2009.



Results

110 published studies were included. The topics and the study characteristics were extremely wide-ranging. The studies assessed patterns of drug use, have tested interventions, supported or improved prescribing practices, tested compliance with the French governmental Health guidelines, assessed physicians' prescribing practices and performed economic and cost-effectiveness assessments. The number of articles published increased greatly between 2002 and 2003.



Conclusions

The French reimbursement databases were greatly used over the last 20 years. They can provide data on exposure to drugs and can be used to study patterns of drug utilization although their limitations must be considered. Copyright © 2010 John Wiley & Sons, Ltd.

Pharmacoepidemiological research using French reimbursement databases: yes we can!†

PURPOSE: To study the use of antidepressants in children and adolescents in Dutch general practice in 2001 and 2005 and to determine off-label prescribing. METHODS: Data were obtained from the Netherlands Information Network of General Practice (LINH) that comprised 97 practices in 2001 and 73 practices in 2005. General practitioners (GPs) recorded prescriptions with their indication in the medical records of the patients during one calendar year. We selected boys and girls aged 0-17 years (n = 83 442 in 2001; n = 62 969 in 2005) and identified those who got prescribed antidepressants (N06A). Prevalence of use, indications and percentage of off-label prescriptions were compared between 2001 and 2005. RESULTS: The prevalence of selective serotonin reuptake inhibitor (SSRI) use decreased from 1.2 to 1.1 per 1000 children and adolescents between 2001 and 2005. The use of tricyclic antidepressants (TCAs) and other antidepressants also decreased (0.8 to 0.7 and 0.3 to 0.2, respectively). TCAs were often prescribed for nocturnal enuresis, but in patients aged 12-17 years hyperactivity was the leading indication in both years. GPs continued to prescribe SSRIs for depression (about half of the prescriptions) after the safety warnings, while venlafaxine prescribed for depression decreased in favour of anxiety. Off-label prescribing of SSRIs increased from 16.7% to 34.4% and that of venlafaxine from 22.2% to 58.3%. All SSRI and venlafaxine prescriptions were unlicensed for age. CONCLUSIONS: The decreased use of SSRIs and venlafaxine suggests an impact of the safety warnings. A point of concern is the enlarged off-label prescribing and insight in the underlying reasons and its appropriateness is needed. (aut. ref.)

/pdf/antidepressant-use-and-off-label-prescribing-in-children-and-2fvahemh5j.pdf

Antidepressant use and off-label prescribing in children and adolescents in Dutch general practice (2001-2005).

Objective: In Europe, little information exists on the pediatric use of psychotropic medication This study aimed to describe the extent and patterns of psychotropic medication use in children and adolescents enrolled in a large health plan (MGEN) in France, and its evolution in recent years Methods: MGEN affiliates aged 0 to 17 years were randomly selected at the end of three consecutive years, 2003 (n = 6534), 2004 (n = 6625), and 2005 (n = 6704) Reimbursement claims were organized into three 1-year cross-sectional data sets Results are detailed for the year 2003 only Results: In 2003, psychotropic medication, principally anxiolytics and hypnotics, concerned 33% of children and adolescents, of whom 350% used only herbal drugs General practitioners were found to be behind most of these prescriptions (635%) and, worryingly, 151% were drugs restricted to adult use Nevertheless, most psychotropic medication users (710%) had only one prescription In general, psychotropic medication users

Psychotropic medication use in children and adolescents: a study from France.

Background and objective To provide an overview of drug use in outpatient children in France, a population-based study using a national reimbursement claims database representative of 90% of the French population was conducted. Design Cross-sectional study performed between January and December 2011 using the EGB database ( Echantillon Generaliste de Beneficiaires ), a 1/97th sample of the national healthcare insurance system beneficiaries. Drug use in children Results In 2011, 133 800 children were included in the study. The overall prevalence of drug use was 84% and the median number of different drugs per child was 5. Drug use was greatest in children aged Conclusions There is widespread use of medicines that are unlikely to be effective and may have significant toxicity in French children. Irrational use of medicines appears to be greatest in children aged 5 years and under.

https://adc.bmj.com/content/archdischild/early/2015/05/14/archdischild-2014-307224.full.pdf

Drug use in French children: a population-based study

Purpose

To determine healthcare claim patterns associated using nonsteroidal anti-inflammatory drugs (NSAIDs) for rheumatoid arthritis (RA).



Methods

The CADEUS study randomly identified NSAID users within the French health insurance database. One-year claims data were extracted, and NSAID indication was obtained from prescribers. Logistic regression was used in a development sample to identify claim patterns predictive of RA and models applied to a validation sample. Analyses were stratified on the dispensation of immunosuppressive agents or specific antirheumatism treatment, and the area under the receiver operating characteristic curve was used to estimate discriminant power.



Results

NSAID indication was provided for 26 259 of the 45 217 patients included in the CADEUS cohort; it was RA for 956 patients. Two models were constructed using the development sample (n = 13 143), stratifying on the dispensation of an immunosuppressive agent or specific antirheumatism treatment. Discriminant power was high for both models (AUC > 0.80) and was not statistically different from that found when applied to the validation sample (n = 13 116).



Conclusions

The models derived from this study may help to identify patients prescribed NSAIDs who are likely to have RA in claims databases without medical data such as treatment indication. Copyright © 2012 John Wiley & Sons, Ltd.

Use of health insurance claim patterns to identify patients using nonsteroidal anti-inflammatory drugs for rheumatoid arthritis.

Purpose

To describe the use of psychotropic drugs in children aged 0–5 years, in the Aquitaine region of South-west France and identify associated socio-demographic, familial and medical factors.



Methods

Data used in this study come from the regional drug claims database of the National Health Insurance System of Aquitaine and from postal self-questionnaires sent to parents and prescribing physicians.



Results

In Aquitaine, psychotropic drugs were redeemed at least once in 2002 for 3.2% of young children. Hydroxyzine, niaprazide or diazepam were claimed at least once by 2.7% of children registered in the database. Prescribers were mostly general practitioners (76.7%) and pediatricians (20.1%). Psychotropic claims were more frequent in children having the highest number of medical consultations in 2002 (more than 7: odds ratio (OR) = 1.5 [95% confidence interval (CI): 1.3–1.7]) or of drug deliveries (7–15 deliveries: OR = 1.8 [95%CI: 1.6–2.1]; more than 15 deliveries: OR = 3.2 [95%CI: 2.7–3.9]). Psychotropic claim frequency increased with age. No association of psychotropic use with parental psychotropic use, socio-professional category and familial situation was found.



Conclusions

Psychotropic delivery prevalence in Aquitaine in young children was below 5% in 2002. It notably concerned drugs of which the use is not devoid of toxicity because of anticholinergic properties. Copyright © 2006 John Wiley & Sons, Ltd.

Corinne Martin-Guehl

Papers

Use of psychotropic drugs in 0 to 5 years old children in Aquitaine (France): prevalence and associated factors.